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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Massachusetts rates for HCPCS L3975

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Rates data updated July 2026.

Facilitymedian $2,239 · 10th–90th $794$3,6310%20%10th90th$2,239Professionalmedian $1,585 · 10th–90th $794$2,3990%20%40%10th90th$1,585$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$870.96
Typical High
$2,630.27
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,737.80
Typical High
$8,709.64
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,412.54
Typical High
$2,187.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$2,344.23
Typical High
$3,090.30
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$2,137.96
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$2,398.83
Health New England
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,737.80
Typical High
$8,709.64
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,412.54
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,023.29
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,513.56
Typical High
$1,698.24